Journal of General Internal Medicine

, Volume 33, Issue 1, pp 116–119 | Cite as

Warm Handoffs: a Novel Strategy to Improve End-of-Rotation Care Transitions

  • Harry S. Saag
  • Jingjing Chen
  • Joshua L. Denson
  • Simon Jones
  • Leora Horwitz
  • Patrick M. Cocks
Innovation and Improvement: Innovations in Medical Education



Hospitalized medical patients undergoing transition of care by house staff teams at the end of a ward rotation are associated with an increased risk of mortality, yet best practices surrounding this transition are lacking.


To assess the impact of a warm handoff protocol for end-of-rotation care transitions.


A large, university-based internal medicine residency using three different training sites.


PGY-2 and PGY-3 internal medicine residents.

Program Description

Implementation of a warm handoff protocol whereby the incoming and outgoing residents meet at the hospital to sign out in-person and jointly round at the bedside on sicker patients using a checklist.

Program Evaluation

An eight-question survey completed by 60 of 99 eligible residents demonstrated that 85% of residents perceived warm handoffs to be safer for patients (p < 0.001), while 98% felt warm handoffs improved their knowledge and comfort level of patients on day 1 of an inpatient rotation (p < 0.001) as compared to prior handoff techniques. Finally, 88% felt warm handoffs were worthwhile despite requiring additional time (p < 0.001).


A warm handoff protocol represents a novel strategy to potentially mitigate the known risks associated with end-of-rotation care transitions. Additional studies analyzing patient outcomes will be needed to assess the impact of this strategy.


care transitions patient safety medical education-graduate 


Compliance with Ethical Standards

Conflict of Interest

The authors declare no conflicts of interest.


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Copyright information

© Society of General Internal Medicine 2017

Authors and Affiliations

  • Harry S. Saag
    • 1
  • Jingjing Chen
    • 2
  • Joshua L. Denson
    • 3
  • Simon Jones
    • 4
  • Leora Horwitz
    • 1
    • 4
  • Patrick M. Cocks
    • 1
  1. 1.Department of General Internal Medicine and Clinical InnovationNYU Langone Medical Center and NYU School of MedicineNew YorkUSA
  2. 2.NYU School of MedicineNew YorkUSA
  3. 3.Division of Pulmonary Sciences and Critical CareUniversity of Colorado School of MedicineDenverUSA
  4. 4.Department of Population HealthNYU School of MedicineNew YorkUSA

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